Dosage & Route

ADULTS

Topical

Apply system, 5–21 mg, once every 24 hr. Dosage is based on response and stage of withdrawal. Nicoderm: 21 mg/day for first 6 wk; 14 mg/day for next 2 wk; 7 mg/day for next 2 wk. Nicotrol: 15 mg/day for 6 wk.

Nasal spray

1 spray in each nostril as needed, one to two doses each hour, up to five doses/hr and 40 doses/day.

Nasal inhaler

1 spray in each nostril, one to two doses/hr to a maximum five doses/hr or 40 doses/day. Dosage is individualized; in studies, best results were achieved by continuous, frequent puffing over 20 min. Do not use longer than 6 mo. Patients are treated for 12 wk, then weaned off the daily dose over next 6–12 wk.

PEDIATRIC PATIENTS

Safety and efficacy in children and adolescents who smoke have not been established.

Therapeutic actions

Nicotine is a potent ganglionic and CNS stimulant. It paralyses all autonomic ganglia after stimulation of the respiratory system (a central effect of small doses). Larger doses produce medullary-type convulsions then paralysis. The actions of nicotine are mediated via nicotine-specific receptors.

Indications

Temporary aid to the cigarette smoker seeking to give up smoking while in a behavioral modification program under medical supervision

Interventions

Protect systems from heat; slight discoloration of system is not significant.

Apply system to nonhairy, clean, dry skin site on upper body or upper outer arm; use only when the pouch is intact; use immediately after removal from pouch; use each system only once.

Wash hands thoroughly after application; do not touch eyes.

Wrap used system in foil pouch of newly applied system; fold over and dispose of immediately to prevent access by pets or children.

Apply new system after 24 hr; do not reuse same site for at least 1 wk. Nicotrol: Apply a new system each day after waking, and remove at bedtime.

WARNING: Handle nasal spray carefully; if it comes in contact with skin, flush immediately; dispose of bottle with cap in place.

Ensure that patient has stopped smoking; if the patient is unable to stop smoking within the first 4 wk of therapy, drug therapy should be stopped. It is understandable that anyone who plans on giving up smoking may find it challenging at first, but with methods such as nicotine patches, nicotine gum, vaping and e liquid for beginners, it has never been easier to finally become a non smoker.

Encourage patients who have been unsuccessful at any dose to take a “therapy holiday” before trying again; counseling should explore factors contributing to their failure and other means of success.

Teaching points

Protect systems from heat; slight discoloration of system is not significant.

Apply system to nonhairy, clean, dry skin site on upper body or upper outer arm; use only when the pouch is intact; use immediately after removal from pouch; use each system only once.

Wash hands thoroughly after application; do not touch eyes. Wrap used system in foil pouch of newly applied system; fold over and dispose of immediately to prevent access by pets or children.

Apply new system after 24 hours; do not reuse same site for at least 1 week. Nicotrol: Apply a new system each day after waking, and remove at bedtime.

Tilt head back to administer spray; do not sniff, swallow, or inhale while spray is administered. If spray comes in contact with skin, flush immediately; discard bottle with cap in place.

Store reusable mouthpiece for inhaler in plastic case; wash with soap and water. Throw inhaler cartridge away out of reach of children and pets.

Abstain from smoking using a suitable solution for the individual. This may include using nicotine patches, products from different vaping companies like Pure E-Liquids, or visiting a therapist.

You may experience these side effects: Dizziness, headache, light-headedness (use caution driving or performing tasks that require alertness); nausea, vomiting, constipation or diarrhea (frequent small meals, regular mouth care may help); skin redness, swelling at application site (good skin care, switching sites daily may help). If you would like to quit then you may want to consider another product to come off it slowly to reduce symptoms from companies such as Grasscity, on their website you can check out products and tools to help accompany your smoking such as vapes, dab rigs, and oil rigs, and for a great price, you may want to check out the difference in dab rigs and oil rigs on this site compared to others if you are on a tight budget.

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